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General NPI Number Information
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NPI Number | 1932990793
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Entity Type | Organization
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Legal Business Name | SEAL BEACH MEDICAL, LLC
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Dates
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Enumeration Date | 05/13/2025
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Last Update Date | 05/13/2025
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Provider Practice Location Address
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Address Line | 1198 PACIFIC COAST HWY SUITE D #519
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City | SEAL BEACH
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State | CA
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Zip | 90740
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Country | US
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Telephone | 562-566-2829
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Fax | 562-550-7560
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Provider Business Mailing Address
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Address Line | 1077 PACIFIC COAST HWY STE 293
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City | SEAL BEACH
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State | CA
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Zip | 90740-6214
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Country | US
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Telephone | 562-566-2829
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Fax | 562-550-7560
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Authorized Official
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Title or Position | COLLETOR
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Name | RICHARD MILLER
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Credential |
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Telephone | 562-566-2829
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 111NX0800X
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Taxonomy Name | Orthopedic Chiropractor
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License Number |
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License Number State |
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